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Physiology of Normal Sleep

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Sleep and Neuropsychiatric Disorders

Abstract

Several neurotransmitter systems and circulating factors regulate rapid eye movement (REM) sleep, non-REM (NREM) sleep, and wakefulness (W). The nuclei involved in the occurrence of W are located in the brainstem, hypothalamus, and the basal forebrain (BFB). These corresponding to the brainstem include the dorsal raphe nucleus (serotonergic neurons); locus coeruleus (noradrenergic neurons); ventral tegmental area, substantia nigra compacta, and ventral periaqueductal gray matter (dopaminergic neurons); and laterodorsal and pedunculopontine tegmental nuclei (cholinergic neurons). The structures found in the hypothalamus comprise the tuberomammillary nucleus (histaminergic neurons) and the posterior and lateral hypothalamus around the fornix (orexinergic neurons). The cholinergic neurons of the BFB are located mainly in the diagonal band of Broca, substantia innominata, and the medial septal area.

The NREM sleep-inducing system comprises neurons located in the preoptic area, which contains Gamma-Aminobutyric Acid (GABA) and galanin, and cells containing melanin-concentrating hormone located in the lateral hypothalamus and incertohypothalamic area. The latter is also involved in the regulation of REM sleep. Somnogens, including adenosine (formed mainly by the breakdown of adenosine nucleotides), prostaglandin D2 (which is mainly present in the leptomeninges, choroid plexus, and oligodendrocytes), nitric oxide (synthesized predominantly from L-arginine), and cytokine promote also sleep, mainly NREM sleep. Melatonin is a hormone secreted during the night from the pineal gland and has a weak sleep-promoting effect in humans.

The subcoeruleus nucleus has been proposed as the critical area for REM sleep regulation in the cat. Its equivalent in the rat is called the sublaterodorsal nucleus. The REM sleep generation region includes mainly glutamatergic and GABAergic neurons.

Sleep timing depends on two factors, sleep debt (process S; homeostasis) and circadian control (process C). When process S approaches the upper boundary, it triggers sleep. On the other hand, the markers of process C include melatonin and core body temperature.

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Author information

Authors and Affiliations

  1. Department of Pharmacology and Therapeutics, University of the Republic School of Medicine, Montevideo, Uruguay

    Jaime M. Monti

  2. University Sleep Disorders Center, Department of Medicine, King Saud University, Riyadh, Saudi Arabia

    Ahmed S. BaHammam

  3. Strategic Technologies Program of the National Plan for Sciences, Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia

    Ahmed S. BaHammam

  4. Somnogen Canada Inc., Toronto, ON, Canada

    S. R. Pandi-Perumal

Authors
  1. Jaime M. Monti
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  3. S. R. Pandi-Perumal
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Correspondence to Jaime M. Monti .

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Editors and Affiliations

  1. Department of Psychiatry and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

    Ravi Gupta

  2. Department of Psychiatry, Johns Hopkins Medical School, Baltimore, MD, USA

    David N. Neubauer

  3. Somnogen Canada Inc., Toronto, ON, Canada

    S. R. Pandi-Perumal

Glossary

Circadian rhythm

is a rhythm with ~24 h periodicity in all living organisms that are synchronized to an environmental light/dark (LD) cycle.

EEG

(electroencephalogram).

EKG

(electrocardiogram).

EMG

(electromyogram) refers to recording muscle activity such as face twitches, teeth grinding, and leg movements; it also helps determine the presence of REM stage sleep.

EOG

(electrooculogram) refers to the recording of eye movement that is particularly important in determining the different stages of sleep, particularly REM stage sleep.

Hypnogram

is a visual depiction of overnight sleep, which shows the relationship between sleep stages.

MSLT

(Multiple Sleep Latency Test).

MWT

(Maintenance of Wakefulness Test).

PSG

(Polysomnography or sleep study) is an attended overnight recording of overnight sleep (usually six or more hours) by means of sleep stages and cycles on a sheet of paper or on a computer screen via electrophysiological signals based on electrode and sensor recording in humans. It is a diagnostic procedure during which several different physiological and pathophysiological (cardiac, arousal, movement, and respiratory events) parameters (such as EEG, EMG, EOG, SpO2, body position, blood pressure, penile tumescence, abnormal movement, and others) are continuously and simultaneously recorded across a sleep period to characterize sleep and identify sleep disorders. During overnight sleep, the following parameters are often recorded: Electroencephalogram (EEG); electromyogram (EMG; jaw, arm, and leg); electrooculogram (EOG); electrocardiogram (ECG); snoring; oro-nasal airflow (L/s) (liter/second) chest and abdomen movements (respiratory effort recordings); oxygen saturation (SpO2); body position; and real-time-video-image recordings (video polysomnography). In addition, depending on the requirements, other parameters such as nocturnal penile tumescence, gastroesophageal reflux, and BP are other electrophysiological signals that can be recorded.

SpO2

Pulse oximetry.

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Monti, J.M., BaHammam, A.S., Pandi-Perumal, S.R. (2022). Physiology of Normal Sleep. In: Gupta, R., Neubauer, D.N., Pandi-Perumal, S.R. (eds) Sleep and Neuropsychiatric Disorders. Springer, Singapore. https://doi.org/10.1007/978-981-16-0123-1_1

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